Lesbian/Gay/Bisexual/Transgender Report Form

To be used by IVC students, faculty and/or staff as well as the community at large.

What would you like to do or know? *

What would you like to do or know?

Report an incident of bullying, harassment or intimidation that was directed at someone because of their real or perceived sexual orientation or gender identity.Recognize someone for positive actionsReceive more information on this program or others that help make IVC a safer and more positive place to learn and work.Receive assistance on a project or request an appearance at a public meeting or event.

Please enter your message below.

Name (You can skip this item if you prefer to remain anonymous.)

Name (You can skip this item if you prefer to remain anonymous.) FirstLast

Enter your first name , then your last name. If you prefer to remain anonymous, then move on to the next field.

Please provide an email address if you prefer being contacted in this manner.

Enter the email address you use most often.

Please provide a telephone number if you prefer being contacted by phone.

Please provide a telephone number if you prefer being contacted by phone.
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How do you identify yourself (required for record-keeping purposes; this will remain confidential)? *

How do you identify yourself (required for record-keeping purposes; this will remain confidential)?

FemaleMaleOther/Decline to state

What is your position at IVC (required for record-keeping purposes)? *